BACKGROUND AND AIMS: Portal vein thrombosis (PVT) is common among patients with cirrhosis, but the independent impact on outcomes and management is uncertain. We aimed to determine whether the development of PVT is independently associated with mortality, bleeding, and hospitalization and whether anticoagulation improves these outcomes. METHODS: Patients with cirrhosis and PVT were identified using billing codes from a large health system between 2016 and 2023 and compared to matched control cirrhosis patients without PVT. Among the cohort with PVT, those who received anticoagulation were compared to those who did not. Outcomes included mortality, gastrointestinal bleeding, and hospitalization. Adjustment for confounding was performed using propensity score analysis. RESULTS: Among 48,596 patients with cirrhosis, 1332 formed the PVT cohort and 3440 formed the non-PVT matched cohort. On adjusted analysis, patients with PVT had higher mortality (hazard ratio [HR] 1.33, CONCLUSIONS: Among patients with cirrhosis, PVT is independently associated with a higher risk of mortality, bleeding, and hospitalization. Anticoagulation may improve overall survival but is associated with a higher risk of bleeding and hospitalization.